Clinical presentation:
24 year old woman from Nigeria with back pain.

There is a subtle defect in the articular surface of the left 12 rib with an adjacent patch of bone destruction. That rib is the only one with uncorticated medial margin. This was missed initially.

There is more extensive bone destruction, involving loss of the medial end of the left 12th rib, and patchy destruction of the left side of the 12th vertebra, including its left pedicle. There is also significant loss of the T11/ T12 disc space, loss of definition of the cortex on the lower left margin of the 11th thoracic vertebral body and an adjacent large para-vertebral soft tissue mass.

This CT scan, taken a little earlier in those days with waiting lists for such imaging, shows a destructive process in the 12th thoracic vertebra, involving the proximal end of the left 12th rib. The process extends behind the left crus of diaphragm. The image contains some overranging artifact and there is probably no calcification in the aorta, which appears so normal in the other cuts.